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Joint implants: An elution solution

Nature Biomedical Engineering volume 1, Article number: 0087 (2017) Cite this article

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An optimized drug-eluting polymer for the surface of articulating artificial joints may make them infection-free.

Infection is an uncommon complication (average rates are in the 1–2% range) that leads to implant failure, and is devastating for patients4. During the primary implantation of the artificial joint, such as a hip implant, the synovium (connective tissue lining the inner surface of synovial joints and tendon sheath) is retained as much as possible so that the implant resides in a similar environment to the native hip. If bacterial colonization occurs, poor antibiotic penetrance and facilitated bacterial biofilm formation in the presence of the implant leaves little choice but for a surgical intervention to remove infected materials. In the case of an established infection, joint components are removed, bone surfaces are debrided, and any remaining synovium is removed. All joint surfaces are aggressively washed with various antiseptics. At this juncture, implantation of a new artificial joint can occur — and fixation of the implant is usually done with bone cement, which can be used as a reservoir for antibiotics. This type of re-implantation is referred to as a one-stage revision, and is often used in Europe. Alternatively, an implanted cement spacer that contains antibiotics and that can bear some weight serves as an antibiotic-elution system. The spacer is usually retained for at least six weeks, during which antibiotic elution, which decreases over time, is designed to prevent the re-establishment of infection. But the antibiotic levels in the spacer compromise its mechanical robustness. After six weeks, if the clinical signs are favourable, the patient undergoes a revision surgery with the implantation of a new, usually cemented artificial joint, thus completing the two-stage procedure commonly used in the United States. With these aggressive measures, successful eradication of infection only occurs in 20–90% of the cases5. To improve antibiotic-elution characteristics, different antibiotic controlled-release systems have been developed6, but they do not elute antibiotics for the necessary several weeks or have sufficient mechanical robustness. Reporting in Nature Biomedical Engineering, Ebru Oral and colleagues now show that a mechanically robust artificial joint designed to include both a long-term antimicrobial surface and an antibiotic-elution system7 allows for long-term retention of the joint implant, which should lead to a decrease of surgical procedures and costs, and ultimately save lives.

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Figure 1: A ball-and-socket hip-joint replacement.
Figure 2: An antimicrobial-eluting implant can prevent periprosthetic infection.

References

  1. Glyn-Jones, S. et al. The Lancet 386, 376–387 (2015).

    CAS  Article  Google Scholar 

  2. Otto M. Annu. Rev. Med. 64, 175–188 (2013).

    CAS  Article  Google Scholar 

  3. Sharkey, P. F., Lichstein, P. M., Shen, C., Tokarski, A. T. & Parvizi, J . J. Arthroplasty 29, 1774–1778 (2014).

    Article  Google Scholar 

  4. Kurtz, S. M., Lau, E., Watson, H., Schmier, J. K. & Parvizi, J. J. Arthroplasty 27, 61–65.e1 (2012).

    Article  Google Scholar 

  5. Chen, A. F., Heller, S. & Parvizi, J. Surg. Clin. North Am. 94, 1265–1281 (2014).

    Article  Google Scholar 

  6. Hickok, N. J. & Shapiro, I. M. Adv. Drug Delivery Rev. 64, 1165–1176 (2012).

    CAS  Article  Google Scholar 

  7. Suhardi, V. J. et al. Nat. Biomed. Eng. 1, 0080 (2017).

    Article  Google Scholar 

  8. Fink, B., Vogt, S., Reinsch, M. & Büchner, H. Clin. Orthop. Relat. Res. 469, 3141–3147 (2011).

    Article  Google Scholar 

  9. Collier, J. P. et al. Clin. Orthop. Relat. Res. 414, 289–304 (2003).

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Sidney Kimmel Medical School of Thomas Jefferson University, 1015 Walnut Street, Suite 501, Philadelphia, 19107, Pennsylvania, USA

    Noreen J. Hickok

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  1. Noreen J. Hickok
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Correspondence to Noreen J. Hickok.

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Hickok, N. Joint implants: An elution solution. Nat Biomed Eng 1, 0087 (2017). https://doi.org/10.1038/s41551-017-0087

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